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Fluid Therapy: Double-Edged Sword during Critical Care?

Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics o...

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Autores principales: Benes, Jan, Kirov, Mikhail, Kuzkov, Vsevolod, Lainscak, Mitja, Molnar, Zsolt, Voga, Gorazd, Monnet, Xavier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700172/
https://www.ncbi.nlm.nih.gov/pubmed/26798642
http://dx.doi.org/10.1155/2015/729075
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author Benes, Jan
Kirov, Mikhail
Kuzkov, Vsevolod
Lainscak, Mitja
Molnar, Zsolt
Voga, Gorazd
Monnet, Xavier
author_facet Benes, Jan
Kirov, Mikhail
Kuzkov, Vsevolod
Lainscak, Mitja
Molnar, Zsolt
Voga, Gorazd
Monnet, Xavier
author_sort Benes, Jan
collection PubMed
description Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing.
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spelling pubmed-47001722016-01-21 Fluid Therapy: Double-Edged Sword during Critical Care? Benes, Jan Kirov, Mikhail Kuzkov, Vsevolod Lainscak, Mitja Molnar, Zsolt Voga, Gorazd Monnet, Xavier Biomed Res Int Review Article Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing. Hindawi Publishing Corporation 2015 2015-12-22 /pmc/articles/PMC4700172/ /pubmed/26798642 http://dx.doi.org/10.1155/2015/729075 Text en Copyright © 2015 Jan Benes et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Benes, Jan
Kirov, Mikhail
Kuzkov, Vsevolod
Lainscak, Mitja
Molnar, Zsolt
Voga, Gorazd
Monnet, Xavier
Fluid Therapy: Double-Edged Sword during Critical Care?
title Fluid Therapy: Double-Edged Sword during Critical Care?
title_full Fluid Therapy: Double-Edged Sword during Critical Care?
title_fullStr Fluid Therapy: Double-Edged Sword during Critical Care?
title_full_unstemmed Fluid Therapy: Double-Edged Sword during Critical Care?
title_short Fluid Therapy: Double-Edged Sword during Critical Care?
title_sort fluid therapy: double-edged sword during critical care?
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700172/
https://www.ncbi.nlm.nih.gov/pubmed/26798642
http://dx.doi.org/10.1155/2015/729075
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